EAL

EE: Body Positions (2014)

Citation:

Sujatha T, Shatrugna V, Venkataramana Y, Begum N. Energy expenditure on household, childcare and occupational activities of women from urban poor households. Br J Nutr. 2000; 83: 497-503.

PubMed ID: 10953674

Study Design:

Descriptive Study

Class:

D - Click here for explanation of classification scheme.

Quality Rating:

NEUTRAL: See Quality Criteria Checklist below.

Research Purpose:

To describe and measure the energy cost of some of the major activities of women from the poor socio-economic group in India.

Inclusion Criteria:

Female
Aged 18 to 40 years
Living in a large urban slum named Addagutta
Worked in home-based occupations or were homemakers.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

Subjects were recruited based on a census that was carried out for another study. The study involved 66 women in home-based occupations or homemakers were randomly selected from this census information in the large urban slum of Addagutta located in the capital city of the region of Andhra Pradesh, India.

Design

Observational data was initially collected by trained investigators to record the various activities of the selected women by observing them during the waking hours on a typical day to identify their predominant activities. Basal metabolic rate was measured in all subjects at baseline. The energy cost of each subjects activities of daily living was measured by open-circuit indirect calorimetry.

Blinding Used

Implied with measurements.

Intervention

Not applicable. Subjects performed their routine activities of daily living and these were not altered for the measurement purposes.

Statistical Analysis

CV were calculated for the energy cost values. ANOVA was used to determine significant differences between means.

Data Collection Summary:

Timing of Measurements

Basal metabolic rate was measured with the patient at rest and minimal disturbances. Subjects were informed of the measurement one day prior to measurement. Indirect calorimetry was used to measure the energy cost of each subject's daily activities for one day.

Dependent Variables

BMR measured while fasting using the Douglas Bag method
Energy expenditure of activities as measured using a Kofranyi-Michaelis spirometer with oxygen content analyzed using a Servomex O₂ analyzer. Energy cost of activities was measured in the post-prandial state and the sample was collected from four to 10 minutes except cooking, which was measured for 15 to 20 minutes. The analyzer was calibrated prior to each use and subjects all wore a nose clip.

Independent Variables

Daily activities included:
- Sitting and standing
- Walking
- Sweeping
- Mopping the floor
- Scouring vessels
- Washing clothes
- Water-fetching
- Cooking
- Arranging utensils
- Clearing the beds
- Bathing and dressing the child
- Sitting and holding the child
- Standing and holding the child
- Walking with the child
- Beedi-making
- Sewing.

Description of Actual Data Sample:

Initial N: 98 subjects were recruited
Attrition (final N): 98 subjects finished the study (32 homemakers, 36 beedi-makers, 30 tailors)
Age: Mean age, 29 years; SD, 5.58 years
Ethnicity: Assumed to be Indian based on the study location
Other relevant demographics: Mean family size, 5.1 persons; SD, 1.09 persons. There were no significant differences in the three occupational groups.
Anthropometrics:
- No significant differences existed between occupations for height
- Mean weight was higher for women tailors when compared with beedi-makers and homemakers (P<0.05):
  - Tailors: 47kg (8.6)
  - Beedi-makers: 42.7kg (7.99)
  - Homemakers: 42.0kg (7.25).
Location: Addagutta, a large urban slum, located in the busiest part of Hyderabad, the capital city of the region of Andhra Pradesh, India.

Summary of Results:

Key Findings

Standard activities such as lying, sitting and standing consumed the least amount of energy among the whole range of activities (2.94kJ to 3.43kJ per minute)
Except for cooking, all household activities and two of the childcare activities required more than 7.9kJ per minute
Occupational activities carried out in a sitting posture consumed less energy than most of the household and childcare activities
Most standard activities could be classified into very light (less than 1.7 BMR) activity
Most household activities were classified into heavy (more than 2.8 BMR) activity
Childcare activities are classified into moderate (2.2 to 2.8 BMR) activity, and occupational activities like tailoring and beedi-making were either very light (1.5 BMR) or light (2.07 BMR)
There was no difference in the energy equivalents for each of the activities in the three occupational groups except for water fetching in the homemakers category. In this group, the energy was significantly lower when compared with the beedi-makers and tailors (P<0.05)
Except for walking, all standard activities and occupational work could be classified into the light category.

**List of Activities Identified From Activity Profile and Energy Cost of Each Activity (Mean, SD)**
	Energy Cost	(kJ per minute)		Energy Cost	(kJ per kg per minute)		Range of Energy Costs
Activity	Mean	SD	CV (%)	Mean	SD	CV (%)	(kJ per kg per minute)
Standard
Lying	2.94	0.405	14	0.066	0.008	13	0.042 to 0.096
Sitting	3.150	0.468	15	0.075	0.012	17	0.071 to 0.075
Standing	3.430	1.196	35	0.079	0.016	21	0.075 to 0.079
Walking	8.160	1.698	21	0.188	0.025	13	0.108 to 0.268
Household
Cooking	5.77	1.087	19	0.125	0.020	17	0.067 to 0.179
Scouring vessels	7.48	1.55	21	0.167	0.033	20	0.096 to 0.280
Arranging vessels and beds	9.12	1.535	17	0.205	0.029	14	0.105 to 0.259
Sweeping	9.37	0.470	21	0.217	0.038	17	0.125 to 0.292
Washing clothes	10.21	2.050	20	0.238	0.050	21	0.125 to 0.376
Water-fetching	12.008	2.430	20	0.280	0.054	19	0.142 to 0.376
Mopping	12.51	2.51	20	0.288	0.046	16	0.201 to 0.430
Childcare
Standing and holding child	4.56	0.870	19	0.105	0.017	16	0.075 to 0.138
Sitting and holding child	5.314	1.104	21	0.138	0.033	24	0.096 to 0.188
Bathing the child	7.866	1.628	21	0.188	0.033	18	0.125 to 0.243
Walking and holding the child	9.188	1.757	19	0.213	0.025	12	0.163 to 2.615
Occupational
Beedi-making	4.393	0.669	15	0.092	0.013	14	0.067 to 0.121
Sewing	5.899	1.280	22	0.125	0.017	13	0.960 to 0.167
Mean CV			23			20

Energy Expenditure During Each Activity in Terms of BMR Multiples and Their Classification Using World Health Organization/Food and Agriculture Organization/United Nations University (1985) Criteria (Mean and Standard Deviations)
	Energy Cost	(kJ per minute)		Energy Cost BMR Factor
Activity	Mean	SD	CV (%)
Very light (less than 1.7 BMR)
Lying	1.00			1.00
Sitting	1.06	0.09	8.5	1.20
Standing	1.14	0.12	10.5	1.50
Beedi-making	1.50	0.04	2.7
Standing and holding child	1.63	0.30	18.4
Light (1.7 to 2.2 BMR)
Sitting with child	1.90	0.30	16.0
Cooking	1.97	0.39	20.0	1.80
Sewing	2.07	0.44
Moderate (2.2 to 2.8 BMR)
Scouring vessels	2.53	0.48	19.0
Bathing the child	2.67	0.51	19.0
Heavy (more than 2.8 BMR)
Walking	2.80	0.12	4.8	3.40
Arranging vessels and bed folding	3.07	0.45	15.0
Walking and holding the child	3.18	0.64	20.0
Sweeping	3.20	0.62	19.4	3.00
Washing clothes	3.50	0.66	19.0	3.00
Water-fetching	4.10	0.89	22.0
Mopping	4.25	0.77	18.0
Mean CV (%)			15.5

Other Findings

The occupational status of the women did not affect the energy expended on the various activities both in terms of kJ per minute and BMR units, except in the case of water-fetching
The four to six hours of occupational work squatting on the floor appears to reduce the efficiency of beedi-makers and tailors while performing the heavy household and childcare activities in the upright posture.

Author Conclusion:

The energy expenditure of activities did not differ significantly between women with different occupations
This study generated a database for energy cost of activities of women from the low socio-economic group of three occupational groups from urban India
This database may be used to calculate the energy expenditures and arrive at energy requirements of women involved in similar activity patterns.

Funding Source:

Other:

Funding was not specified.

Reviewer Comments:

Questionable validity of indirect calorimetry method to analyze energy expenditure of activities.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	Yes
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	N/A
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		Yes
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	Yes
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	Yes
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	Yes
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	Yes
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	Yes
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	N/A
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		???
	10.1.	Were sources of funding and investigators' affiliations described?	???
	10.2.	Was the study free from apparent conflict of interest?	???